Rupture of a cesarean-scarred uterus: a community hospital experience.

Concerns that a scarred uterus may rupture during labor have contributed to increased cesarean rates. A previous cesarean has become one of the most common indications for abdominal birth. More women must deliver vaginally after cesarean if we are to reduce cesarean rates. This study evaluates the effect of decreasing cesarean rates and increased vaginal birth after cesarean (VBAC) rates on the incidence of uterine rupture in a community hospital. We studied data for women who delivered at our obstetrical unit from 1988 through 1997. During 1994 our department adopted strategies to reduce cesarean rates. Data from women who delivered from 1988 through 1993 (period A, before the policy change) were compared with data for those who delivered from 1994 through 1997 (period B, after the policy change) and evaluated by chi-square analysis. p < 0.05 was considered significant. The total cesarean rate decreased from 24.3% (period A) to 17.9% (period B) (p < 0.0001), whereas the primary cesarean rate decreased from 14.9% to 10.3% (p < 0.0001), and the repeat rate decreased from 9.4% to 7.6% (p < 0.0001). The VBAC rate increased from 13.0 to 28.6 (p < 0.0001), whereas the incidence of uterine rupture did not change. During the study period, the cesarean rate decreased while the VBAC rate safely increased. The incidence of uterine rupture remained unchanged.